Provider Demographics
NPI:1235272170
Name:BROADWATER RINALDI CARE CENTER, LLC
Entity Type:Organization
Organization Name:BROADWATER RINALDI CARE CENTER, LLC
Other - Org Name:RINALDI CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-368-1862
Mailing Address - Street 1:16553 RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3762
Mailing Address - Country:US
Mailing Address - Phone:818-360-1003
Mailing Address - Fax:818-363-8913
Practice Address - Street 1:16553 RINALDI ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3762
Practice Address - Country:US
Practice Address - Phone:818-360-1003
Practice Address - Fax:818-363-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA920000057314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235272170Medicaid
CA6082990001Medicare NSC
CA055906Medicare Oscar/Certification